Dáil Éireann Debate, Wednesday - 22 November 2017
170. Deputy Billy Kelleher asked the Minister for Health the enforcement measures in place with regard to the 80/20 public private split in hospitals; if it is departmental policy to allow individual hospitals to disregard this rule as long as the overall hospital group comes in around the target; and if he will make a statement on the matter. [49599/17]
Amharc ar fhreagraA key objective of Consultant Contract 2008 is to improve access for public patients to public hospital care. Latest data from September 2017 shows that the public/private mix at a system level stands at 82% public for elective in-patient work and at almost 86% for day-case work. This is consistent with the typical 80/20 split provided for in the consultant contract.
The Contract allows consultants engage in differing levels of private practice, depending on the contract type held. Consultants holding a Type A contract are not permitted to engage in privately remunerated professional practice. Consultants holding a Type B contract may undertake private practice on-site, up to a limit of 20% of activity on a casemix-adjusted basis, and limited off-site private practice in cases where the individual consultant previously held a Category I or Category II contract under Consultant Contract 1997. Serving consultants whose public to private ratio in 2006 was greater than 20% are permitted to retain this higher ratio, subject to an overriding maximum ratio of 70:30%. Consultants holding a B* Contract or a Type C Contract may engage in off-site private practice. Their in-patient and out-patient private practice activity is also subject to maximum limits.
Arrangements concerning implementation and monitoring of Consultant Contract 2008, including the provisions in relation to private practice, are matters for the HSE in the first instance. Section 20 of the Contract provides a framework for the regulation of private practice, monitoring of the applicable ratio and steps to be taken where it is exceeded. It is incumbent on publicly-funded hospitals to ensure compliance with the terms of the contract, including the provisions in relation to private practice.
My Department has written to the HSE in recent months requesting that the HSE satisfy itself that no consultant is engaged, or will be permitted to engage, in private practice beyond the level, if any, provided for in their contract. I have asked the HSE to ensure that more robust measures are in place in 2018 to make sure consultants comply with their contractual obligations.
